03D2041753 CLIA NUMBER - WICKENBURG DIALYSIS

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Laboratory Demographics

CLIA Number: 03D2041753

Facility Name: WICKENBURG DIALYSIS

Facility Address:
811 N TEGNER ST STE 101
WICKENBURG, AZ
ZIP 85390
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Facility Phone Number: 928 684-6898

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1093071821

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2041753
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WICKENBURG DIALYSIS
Street	811 N TEGNER ST STE 101
City	WICKENBURG
State	AZ
ZIP	85390
Phone	928 684-6898
CertificateType	4
CertificateEffectiveDate	5/29/2022
CertificateExpirationDate	5/28/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024